Name ___________________________________

Social Security# ________________

Address __________________________________________________

Home Phone___________________ Work Phone _________________

LOCATION:

MAIN SOUTH/DAY SOUTH/WEEKEND
EAST   WEXFORD     GROVE CITY
ERIE    HARRISBURG

R. E. Fundamentals Date _______________ Cost $178
R. E. Practice Date ___________________ Cost $178
Textbook and Materials (one time fee for both classes) Cost $49.00

Payment:

Check (made payable to Alan Kells Schools)

MasterCard Visa Account Number _________________________
(circle one)
Expiration Date___________________________

Signature_________________________________

Mail this form with payment to:
Alan Kells Schools of Real Estate
119 Gamma Drive
Pittsburgh, PA 15238

How did you hear of Alan Kells Schools of Real Estate?_____________________________

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